The proposed competitive renewal study seeks to test a comprehensive model of buffers of disability and diminished quality of life for community- dwelling elderly with and without arthritis. We will examine how quality of medical care and proactive adaptations undertaken by old-old adults (80+) lessen the adverse impact of arthritis on their ability to function and help maximize the quality of their lives. Physicians and patients are seen as partners in care, with the patient-responsive medical care of physicians enhancing the proactive adaptations (physical activity and environmental modifications) of patients. The proposed research will extend our prior NEOMAMDC-funded longitudinal study in both time and space. We will obtained a long term longitudinal follow-up of our original Florida-based elderly cohort. In addition, we will extend our research from relatively healthy and affluent adults living in sunbelt retirement communities to now also include a broader cross-section of urban elderly and racial minorities, and thereby consider the process of arthritis- related disablement in an increasingly frail population of community- living elders of diverse racial and socioeconomic backgrounds. We will collects three annual waves of data based on in-home interviews of an estimated 419 respondents in Florida and 3865 respondents in Cleveland. A combined sample of 658 elderly persons is projected for the third year follow-up. Additionally, we will use least squares regression, structural equations, and latent growth curve analysis to test our comprehensive causal model regarding buffers of the disability cascade. More specifically, we will examine the buffering effect of patient-responsive medical care and proactive adaptation on the progression from arthritis to disability and diminished quality of life. Findings from the proposed study will be useful to clinicians, service providers, policy makers, and others attempting to minimize arthritis-induced disability and enhance quality of life among the elderly.